Bilateral Sequential Dacryocystitis in a Patient With Graft-Versus-Host Disease

Abstract

A 29-year-old woman with a history of 2 bone marrow transplants for acute myelogenous leukemia developed bilateral sequential dacryocystitis in the context of known ocular graft-versus-host disease. With each infection, the patient underwent uneventful dacryocystorhinostomy. Postoperatively, she developed severe dry eye disease requiring replacement of punctal plugs and use of a prosthetic replacement of the ocular surface ecosystem lens. Histopathologic and immunohistochemical examination of the lacrimal sac showed a dense diffuse nonfollicular lymphocytic subepithelial infiltrate in the lacrimal sac that contained moderately more T-cells than B-cells. This is the first report of acute dacryocystitis associated with graft-versus-host disease. The authors caution that similar patients may develop worsening of ocular surface dryness due to restoration of normal lacrimal outflow.

Update on ocular graft-versus-host disease

“…[ 53 66 67 ] Bilateral nasolacrimal duct obstruction (NLDO) leading to dacryocystitis has been reported in oGVHD. [ 68 69 ] NLDO induced by epithelial and subepithelial inflammation and punctal occlusion – both inflammatory and spontaneous have also been observed. [ 70 71 ]…”